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Thread: Ask a PT

  1. #131
    I am working hard on my balance and would like to know if there are any programs out there that are concentrating on this? Are there any studies that have taken a look at the efficacy of different techniques? I am currently doing what I call dynamic standing and bending. I stand with my legs in different positions and bend at the waist while trying to maintain my balance. I am also doing different types of bridges using a swiss ball, one leg, etc. to strengthen my lower back and glutes as well squats with one leg on a box. I have only been at this for a couple weeks now so it is too early to know if it is working. I use crutches fulltime and am afraid I may be letting my balance muscles off the hook too much. I don't want to hobble so I do very little walking unassisted. I have gone from wheelchair to walker to crutches in 10 months following T12 fracture disclocation. I know that I am doing great, but I want more. Sorry I am greedy.

  2. #132
    Over the summer i spent a lot of time on a slack line (basically a stretchy tight rope). I ran another rope above the tightrope for stability when I needed it, but that became less and less frequent with practice, and practice absolutely destroyed my core, abductors and adductors (even when I was able bodied, a day on the slack line made me sore).

    Your progression is not unlike mine, so if you happen to know of any slacklining hippies in your area, give it a shot - it's a lot easier than it looks when you have a rope to grab onto. But if not, I think surfing on your knees is already on the cutting edge. The only reason slacklining worked so well for me was because I enjoyed it and did it a lot, with the awesome balance workout being a nice benefit. Enjoying it and doing it a lot is ten times more effective than any special workout technique, in my opinion.

    Sounds like surfing is a similar deal for you. You enjoy it, do it a lot and I imagine that it takes a lot of hip and core effort to keep stable. That will do wonders. One thing to consider is that maybe you should try hobbling around a bit, to whatever extent you can. I too avoid walking unaided most of the time and use a cane because the asymmetry in my unaided gait is bad news for joints and back muscles, but I definitely spend as much time as I can walking with nothing.

    You're not going to get better on the balance without practicing a lot, even if it's ugly. I've only really started walking unaided in the past month or two and the balance improvement has been pretty drastic. Now I can walk around in a dark room no problem, for instance.

    Good luck!
    L2 incomplete with a pretty bad limp since 10/31/2011.

  3. #133
    Good advice shveddy! I agree
    Strengthening is very important to improve balance, and spending time challenging your balance is also beneficial.
    I like the idea of challenging your balance with an activity - that would be fun. The slackline is interesting. Be safe! And protect your joints for the long haul. Keep working hard, and you will continue to see results. It has been quite the year for you.

    As far as studies... nope. There is not much out there in the way of documented interventions. Now there are more locomotor training studies going on. But the big picture is that more research is needed so that more therapy can be covered by insurance! When we don't have numbers to back up our treatments, they don't get covered
    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  4. #134
    SCI Total Fitness- Quick question if you don't mind.

    It seeems that the locking mechanism in my knee is loose. It is hard to get to a spot where it stays flexed. When it gets right to the point of locking it either locks or gets loose. It is hard to describe. When it is locked it is solid and when it bends further it is solid. Any thoughts on how I can strengthen this?

  5. #135
    Good question - I am sure many people with incomplete injuries have this issue.

    When the knee is completely locked straight, you are relying on your joint structures more than you muscle strength. You're very stable here, but over time, you can wear on your ligaments. You don't want future issues arising, which is why this isn't recommended.

    This can be happening for a few reasons (sorry!). One is strength. The quads are most responsible for knee position, so strengthening these are key. However, you also have the hamstrings and ITB which cross the knee, and unfortunately an imbalance of strength could contribute... and the hamstrings and ITB are generally weak/absent after many spinal injuries.

    One is sensation. If your proprioception is impaired, your joint doesn't know where that "sweet spot" is. So it locks out to get extra input from the joint and ligaments, or bends more to get extra input from muscles.

    Another is what is going on at your ankle - if you're lacking range in the ankle, the knee compensates.

    And lastly, it could be what is going on at the hip - if you're weak, especially with hip extension, the knee will compensate.

    As you can see, this is not a simple question that can be answered without an exam. I would recommend getting an evaluation from a local physical therapist to determine which of the above (an it could unfortunately be multifactorial ) is going on with you and how to best address it.
    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  6. #136
    Thank you so much. You have hit on some issues that relate to me here for sure.

    I do have a weak hamstring on that leg which is starting to strengthen but ever so slowly. My sensation sucks on the lower part of that leg as well and my ankle is practically none existent.

    It seems my problems are multifactorial. I don't have a PT. I have been going it on my own for the 6 months as I cannot afford therapy.

    I will keep working on quad and hammy strength and continue with my balance stuff which helps isolate that leg and forces me to fight back the compensation urge.

    Unfortunately I have to wait and see on the ankle, but I'm not holding my breath.

    Would working the muscle right at that sweet spot help? I do alot of squats and stuff in my balance routine.

    Thanks again.

  7. #137
    I don't think you have to work the muscle "at the sweet spot" necessarily. I would start challenging yourself in more difficult positions to improve your balance. Can you hold a squat while you bring your arms over your head? Or twist your torso?
    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  8. #138
    Senior Member iskumbro's Avatar
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    I love this thread.
    (Learning a lot just by reading)
    He ai'nt heavy, he is my brother!
    Rufus Wainright

  9. #139
    SCITotalfitness- Thank you. I am focusing more on my quads and balance. I am just going to keep doing a full ROM. Lots of squats in different positions. I plan to try one of your work outs.

  10. #140

    Exercise and recovery in the water

    Hello everyone: I am new in the forum and I find it very enriching for everyone. I hope I can be of help as I work with SCI people but in the water atmosphere which is my passion. I have a video posted in youtube that has had great repercussion and I hope It helps and motivates you.

    Below is the attached link. However, in the future 'c6 complete quad swim' can be typed in order to find it.

    I strongly recommend to take advantage of the water for quality lifestyle. Hydrostatic pressure helps tremendously. However, each case is different and previous homework should be done on 'do's and don'ts.

    Cheers and splash!!

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